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십이지장 궤양 출혈의 내시경 지혈술 후 발견된 분리췌장
최용혁 ( Yong Hyeok Choi ),윤순만 ( Soon Man Yoon ),김은비 ( Eun Bee Kim ),오영민 ( Youngmin Oh ),김근모 ( Keunmo Kim ),이지선 ( Jisun Lee ),박선미 ( Seon Mee Park ),윤세진 ( Sei Jin Youn ) 대한소화기학회 2017 대한소화기학회지 Vol.69 No.4
Peptic ulcer bleeding is treated using endoscopic hemostasis using clips or bands. Pancreas divisum (PD), a congenital anomaly of the pancreas, usually has no clinical symptoms; however, pancreatitis may occur if there are disturbances in the drainage of pancreatic secretions. We report an unusual case of PD accompanied by acute pancreatitis, following endoscopic band ligation for duodenal ulcer bleeding. A 48-year-old woman was admitted to our hospital due to melena. An upper endoscopy revealed a small ulcer with oozing adjacent minor papilla. An endoscopic band ligation was performed on this lesion. Acute pancreatitis developed suddenly 6 hours after the band ligation and improved dramatically after removal of the band. Magnetic resonance cholangiopancreatography was performed, revealing complete PD. Endoscopic band ligation is known as the effective method for peptic ulcer bleeding; however, it should be used carefully in duodenal ulcer bleeding near the minor duodenal papilla due to the possibility of PD. (Korean J Gastroenterol 2017;69:248-252)
팽대부 선근종의 임상적, 병리학적, 면역조직화학염색의 특징
최용혁 ( Yong Hyeok Choi ),김미진 ( Mi Jin Kim ),한정호 ( Joung Ho Han ),윤순만 ( Soon Man Yoon ),채희복 ( Hee Bok Chae ),윤세진 ( Sei Jin Youn ),강민호 ( Min Ho Kang ),성노현 ( Rohyun Sung ),최재운 ( Jae Woon Choi ),박선미 ( Seon 대한소화기학회 2013 대한소화기학회지 Vol.62 No.6
Background/Aims: Ampullary adenomyoma is a benign lesion whose malignant potential has yet to be confirmed. Despite its benign nature, adenomyoma is frequently misdiagnosed as a carcinoma or adenoma and is overtreated by extensive surgery. This study was performed to analyze the clinical, pathological, and immunohistochemical features of adenomyomas in the ampulla of Vater. Methods: Nine cases of adenomyoma in the ampulla of Vater, diagnosed in Chungbuk National University Hospital between 2008 and 2011, were enrolled in this study. We reviewed the clinical data on the symptoms, laboratory data, and radiologic findings of the abdominal computed tomography and endoscopic retrograde cholangiopancreatography. For pathological analysis, all the slides were reviewed by one pathologist, and immunohistochemical stainings with antibodies against cytokeratin 7 (CK7), cytokeratin 20 (CK20), α-smooth muscle actin (α-SMA), and Ki-67 antigen were performed. Results: All the cases were CK7 positive and CK20 negative. A strong cytoplasmic expression of α-SMA was confirmed in all cases. The Ki-67 index was less than 1% in eight cases and 5% in one case. Four cases underwent endoscopic papillectomy, and one case received surgical ampullectomy during colorectal cancer surgery. Five cases that underwent endoscopic or surgical treatment remained symptom-free for three years. Four cases that were closely observed with repeated endoscopic examinations exhibited no interval changes in the papillary lesions. Conclusions: Endoscopic biopsy and immunohistochemistry can aid in the diagnosis of ampullary adenomyomas. Endoscopic papillectomy or surgical ampullectomy is adequate for the treatment of symptomatic ampullary adenomyomas. (Korean J Gastroenterol 2013;62:352-358)
Acetazolamide에 의해 발생한 핍뇨성 급성신부전 1예
김혜영 ( Hye Young Kim ),이희승 ( Hee Seung Lee ),김선문 ( Sun Moon Kim ),권순길 ( Soon Kil Kwon ),최용혁 ( Yong Hyeok Choi ),나소영 ( So Young Rha ) 대한내과학회 2012 대한내과학회지 Vol.83 No.5
Acetazolamide is a carbonic anhydrase inhibitor commonly used to treat glaucoma. It can cause metabolic acidosis and renal failure in the elderly and patients with chronic renal insufficiency. We report oliguric acute renal failure (ARF) caused by a conventional dose of acetazolamide for glaucoma in a patient with normal renal function. A 56-year-old woman with 20-year history of diabetes had general weakness, decreased urine output, nausea, and vomiting for 3 days. For the past 2 weeks, her glaucoma had been treated with acetazolamide. Blood-gas analysis showed pH 7.02, PCO2 27 mmHg, PO2 135 mmHg, and HCO3 - 7.0 mmol/L. Her BUN was 65 mg/dL and creatinine, 9.1 mg/dL. She recovered after hemodialysis and hydration. Acetazolamide may cause severe ARF, even in patients with normal renal function, suggesting the importance of careful monitoring of renal function in patients taking acetazolamide. (Korean J Med 2012;83:664-667)